In December last year, Oracle’s Christmas gift to itself was the purchase of technology healthcare provider Cerner - for a whopping $28.3 billion. The acquisition, I’m told by those close to Oracle co-founder and CTO Larry Ellison, is one that he and the company have been eyeing for some time. And is one that Ellison is incredibly passionate about.
The COVID-19 pandemic, it seems, has proven to Oracle that healthcare provision in the United States, and beyond, has to change. And the vendor’s vision is incredibly ambitious: creating a national US healthcare database (and a global one too)
Last week at Oracle CloudWorld, the company’s annual user event, Ellison took to the stage to mostly talk about healthcare - a very different keynote from what we are used to at these events, where enterprise strategy and swiping at cloud competitors is the norm.
Ellison provided example after example of how almost none of the healthcare systems that store patient data in the US talk to each other or share data, creating an incredibly fragmented patient experience. For instance, a New York resident that visits a particular hospital for care, when on holiday in Los Angeles, would likely have to provide a whole host of data to the hospital there if they were unwell. It’s more than likely that the two healthcare providers don’t share data and don’t integrate their systems - so to the hospital in Los Angeles the patient is an entirely new ‘customer’.
Oracle’s plan, via its acquisition of Cerner, is to aggregate electronic healthcare data at a national level, and if the patient so chooses, can access it anywhere. Taking this further, Oracle also envisions a world where you could share data internationally at a global level. Ellison said:
We’ve built fabulous global systems for credit, but not for health. We prioritize shopping way above health, and that is not right
One might argue that there’s a reason that we haven’t replicated a global healthcare system in the way that we have for credit, but more on that later.
Speaking to the fragmented nature of the market, Ellison said:
The big healthcare technology providers have focused on selling systems to one segment of the healthcare ecosystem: big hospitals. So the hospital buys the system, operates the system, and they have their own database - each hospital has their own database of electronic health records.
Basically the current generation of healthcare systems put the providers, the hospitals, at the center of the healthcare system. Not patients. And that’s a fundamental flaw. What we’re intending to do is we’re going to keep providing hospitals with clinical systems, we’re not going to stop doing that.
But we’re also going to build additional systems. We’re going to layer on top of that a national public health electronic database. There’s going to be one national US electronic health record database. So there’s going to be one place you can go to find all of your health records.
The COVID-19 pandemic, said Ellison, has proven to the US and most of the world that we are unprepared for major health crises. We need to be better prepared next time and much of this comes down to better data systems to analyze healthcare records, he added. But beyond the ‘world in crisis’ motive, Ellison also believes that patients are currently underserved in their healthcare experiences, even during the status quo. He said:
Your healthcare records are stored in databases owned by every provider you’ve ever visited in your entire life. It’s terribly fragmented. And this creates a number of problems.
There will be some of that data that you will want to share with other nations to provide a worldwide global health system. We are going to build two new public health systems, one national and one global. It was very clear during the COVID-19 pandemic that we are in desperate need of both of those systems if we are going to do a better job of managing healthcare, especially during a crisis.
In addition, we are going to build a patient engagement system that makes it very easy for patients and medical professionals to communicate, making it very easy for patients to share their health experience with medical professionals. We’re going to automate that connection, between patients and providers.
There will be challenges
Listening to Oracle’s new healthcare agenda, I was fascinated by the scale of what the company is trying to achieve. This is something that has been spoken about in healthcare and technology circles for years, but is not something that anyone has been able to achieve in reality.
Even the UK, which is well positioned compared to the United States to do this, given that it has a national healthcare system that already operates using unique patient identifiers, has failed to successfully launch a national healthcare database where data is shared for research and with other providers (even if the data is anonymized). This is largely because patients are very cautious about who has access to their healthcare data and in some instances would rather their data was fragmented.
An example last year saw the UK attempting to collate all of its General Practice data, when the government thought it had momentum during the COVID-19 pandemic to make better use of healthcare data, but ultimately failed because of privacy concerns and a public backlash.
Of course, having a private healthcare system in the US makes things a bit easier in some ways on this front, as there is potentially more appetite for a company holding your data, rather than a government - but it would be naive to think that there won’t be concerns. Oracle is aware of this and given its background in securing the data of some of the largest enterprises in the world, it arguably has a better chance than any company out there to convince the public.
But Oracle isn’t just talking about its security credentials, it is also leading with the art of the possible and wants to show patients that they are being woefully underserved by their (expensive) healthcare provision at the moment. A positive experience where you get something worthwhile for sharing your data has worked well for other companies.
I got the chance to sit down with Mike Sicilia, Oracle’s VP of Industries, who is very involved with Oracle’s healthcare agenda, to discuss some of these challenges and opportunities. Speaking to why others have failed where Oracle hopes to succeed, Sicilia noted that it’s the unwillingness to take on the scale of the challenge that has doomed others’ initiatives. He said:
We decided that we should not just dip our toe in the water, but we should jump into the deep end here and do something that’s big and ambitious. Now we are also cognizant of the fact that others in big tech have tried and failed. They’ve pulled back their initiatives and they’ve stopped investing. And I think the reason is that they haven’t been willing to take on the entirety of the problem.
What they’ve done is they’ve avoided things like EHR (electronic healthcare records), which everybody knows are difficult - there’s lots of scrutiny, it’s highly regulated and nobody wants to get into that. So they tried to build some fancy stuff around it. But that’s the core of the problem today, and unless you solve that problem, all of the fancy stuff around it doesn’t really matter.
Convincing people of the benefits
Sicilia said that Oracle is fully aware that the reason healthcare environments have been notoriously poor at sharing data is for a number of reasons that include security, privacy and ‘pride of ownership’ (the belief that owning the datasets is a competitive advantage). But he believes that if Oracle can prove value in the sharing of data, this will move the needle. Sicilia explained:
Our strategy is not only to enable the sharing of data - we don’t own any of the data, we can’t see any of the data, it’s not our data, it belongs to the patients and providers - but I think if we can give them actionable insights and really interesting analytics on top of it, we will see a more receptive community around sharing data.
And Sicilia was keen to reiterate the point that whilst Oracle will act as an aggregate layer for the national database, it won’t be able to see the data itself. He said:
We own no data. What’s one of the most interesting things about our cloud is that our engineers can never see the data. We have no telemetry into the actual data. We can see the structure of the data, we can see how many records are in the database. But we are not party to anyone’s data - not even anonymized or de-identified data, that belongs to the custodians.
Equally, Oracle believes by adopting a strategy of not forcing healthcare providers (hospitals) to change their existing systems, the company will have more luck with its strategy than others have had. He said:
We’ve got to meet people where they are to create national systems. Over time we think we have much better provider systems. But we’re going to go in and create a connector into the database on behalf of the government, and that de-identified data that you choose to share will go into the national database. What we are talking about today is that it can be done. Technology is not the barrier. COVID-19 has proven how woefully unprepared we are.
I put it to Sicilia that some will be concerned about one company holding so much of the nation’s healthcare data - even if it's de-identified and anonymized (again, the UK experience has been that this isn’t enough to convince people - albeit, prior to COVID-19). But Sicilia is convinced Oracle can win the hearts and minds and trust of patients. He added:
You would need to be an incredibly sophisticated cyber researcher to re-identify that data at any given point. It’s fear and uncertainty about something new. And prior to COVID I think there was a fear that ‘there’s always something that could go wrong’.
It’s going to take some time for people to get over that fear and for the technology to prove itself. But I would say this, each one of those individual systems at the moment is inherently less secure than a central system with a single perimeter to defend. I think it’s just going to take time for people to get that.
And ultimately, this is about better healthcare provision for the nation. Sicilia said:
We’re very lucky that COVID wasn’t as lethal as it could have been. If COVID was Ebola we’d have a huge problem on our hands. And even COVID showed the weaknesses in our system. We’ve got to be better prepared for the future.
Oracle’s vision is a grand one and one that I admire. There aren’t many companies out there that I think have the clout, systems, or know how to pull this off - but as we’ve learnt time and time again, don’t underestimate Ellison. Any concern about patient data and privacy is a valid one. People have been proven right time and time again that there are unknown consequences for handing your data over to a company. That being said, Oracle is hitting the right notes with how it will deal with this - proving it has the security chops, whilst simultaneously leading with how this will improve healthcare for all and the patient experience. Attitudes have changed post COVID-19 and I think there is a general agreement that we need to be smarter with our data when it comes to healthcare. I will be following this closely as I think it’s going to be an incredibly interesting journey for the company.